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Tuesday, October 2, 2012

Pre-Op Right Hip/Post-Op Left Hip Appointment

After an extremely uneventful travel out to Vail, we had a day and a half to spare before I had my appointments with Dr. P.  On Saturday, it was a washout, because when I arrived in Vail, I decided, against my will, to get a migraine.  I am assuming it was the perfect combo of stress and pressure changes in the mountains.  This landed me in bed with the curtains drawn and a moist towel on my eyes for several hours followed by several hours of sleep.  Essentially the entire day and evening were shot.

Sunday came and it had simply turned into a headache.  Which is something I can totally handle.  On Sunday we went to Wal-Mart and got all the food we needed for the week, plus some other small things. Then we walked around Vail Village.  It was so incredibly beautiful in the fall.  I can say that I have been to Vail in all the seasons, but, autumn by far is the most beautiful.  We walked all through the Village and farmers market.  It was a lovely sunny Sunday afternoon and I enjoyed every single minute of the day (with the exception of having the nagging hip pain, but that is completely expected when you are actually there in Vail to have your hip fixed).  In the evening we watched several shows on HGTV and a couple of Intervention shows (I haven't a clue why I like watching this show as it gives me cognitive dissonance!)

Monday rolled around, and this was the big pre-op day.  At 9:00AM, I had a sports endurance test. This started out with single legged squats on the right side.  I did about two minutes of it.  Then came jumping laterally from my right side onto my left with an elastic band doohickey around my waist.  It wasn’t great, but at least I could do it.  Next was the same thing but lateral jumps.  My left hip would not allow me to do it without pain, so we stopped.  Then I  did (aka tried) some lunges.  I attempted both hips and then looked back at the dude doing the test, where he said that they didn’t count and we stopped the test.  Needless to say, I failed.  But not unexpected.

At 10:30AM, I had measurements with the athletic therapist and PA (plus some additional help with the OR nurse).  We measured strength and ROM.  Both sides were similar, but my left side hurt a bit more.  My FABER was 21cm on my right side and 22cm on my left side. The only thing that stood out between the two sides is my left side flexion was much weaker than my right and my ROM was still less on the left compared to the right side.  Ugh to say the least when the left is going to be the sole weight bearing side in a matter of hours.

This appointment continued on with the OR nurse having me sign consent and have me fill out a post op questionnaire, and a whole bunch of other papers.  Gross.  She is so, so, so nice.  She definitely has the mother figure of the Steadman Clinic going on!  Then the fellow came in, did a very rough hip exam on both sides.  He came to the conclusion that my left side was still unstable!  I made it very clear that I had had that capsule tightened twice this year.  He said that it must have loosened up again.  WHAT?!  He then proceeded to flex my right hip up to max flexion which is about 90*.  When it was there he kept pushing and asking if that was all it did.  To which I replied YES!  In my mind, OUCHIE.  Then the fellow went through my MRI and radiographs.  I have slight dysplasia (CE angle of 26* on the right and 28* on the left).  We discussed the chances of having an osteotomy.  To which he replied that it could be a possibility, but that it isn’t a concern until the CE angle changes to the teens.  This could happen, but this does not contraindicate my chances of having a successful hip scope.  We will keep an eye on the angles in the future and cross that path if/when we get there.  He said that I we would definitely need to repair the labrum, maybe a labral reconstruction/augmentation, CAM and pincer impingement removal.  And my acetabular rim is fractured off just a tad and they will remove the bone and fix the fracture site.

Then I waited for an hour and half for Dr. P to come in.   When he did, the first thing he said was, “oh yes, I remember you, you are a very difficult case".  He proceeded to explain to the fellow that I had a very extensive history with less than optimal surgical outcomes using standard rehab protocols. When Dr. P did the more gentle hip exam, he said that it felt much better than before.  The fellow piped in saying that they were both still tight.  Dr. P said he should have felt my previous left hip stiffness and that I have the stiffest hips he has ever seen.  And that tomorrow they would have to be very, very careful with any tissue manipulation because of my response to surgery.  

He had me walk, and he was very happy considering my lovely hips. I said that I think that the pain is muscular, and he said that although he is happy with the functional improvements, the pain concerns him and that it is not good enough for him and that we have to try more injections and see if the pain resolves.  So in surgery tomorrow he will be doing an intraarticular injection into my left hip, removing some left over suture from the last surgery.  Then he will do a right hip scope with the aforementioned procedures (although I signed for a bunch more procedures that include microfracture….hope I don’t need that).  Then we discussed injecting  my right hip after surgery.  He is going to give a talk at a meeting out of town, but he has taught another doctor to give US guided injection on Friday (three days post op).  He said he wishes he could be here to inject but that it isn’t possible.  And that I need it done because we have seen what prior surgeries have done, that we have to take every precaution to reduce inflammation. 

I then got a pregnancy test, dropped off my scripts, and saw the preop nurse, took my vitals, and, DONE.  It's GO TIME!!!!!

PS. Since I am writing this post several days after the fact, I should mention that October 2nd is my 4th year hippiversary for the right side.  10/02/08 was my very first hip surgery and the last time somebody was inside my right hip.  This most recent surgery was exactly one week shy of four years.  It is crazy how much has changed since then.

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